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Form No: AAA-AAA-MT SOPHIA-NC-NC-PA-R(IP- QUEST)-17-00003

Rev : 00 (F16/HQ)

NON-CONFORMANCE AND CORRECTIVE & PREVENTIVE ACTION REQUEST
Section 1 Non-conformance Report

a) Nature of non-conformance / Nature of potential non-conformance
Nature of non-conformance

b)In-house / External
in-house

c) Description of non-conformance / Areas of potential non-conformance
in house

Raised By: Applicant Signature:

Date: 21/02/2017

d) Causes of non-conformance (Not applicable for potential non-conformance)
not applicable

Completed By : Supervisor Signature :

Date: 21/02/2017

e) Investigation findings and disposition (Not applicable for potential non-conformity)
–
Causes of Non-conformity:
–
Disposition Decision

–      Repair / Rework Accept with or w/o rectification  Regrade for alt Application
–      Reject Corrective Action Not Required Corrective Action Requir
Recommended By   Recommended By
HOD / PM / Appointed Staff HOD / PM
Date: Date:
(Name / Signature / Date) (Name / Signature / Date)

Section 2 Corrective Or Preventive Action Report

Recommended By   Recommended By
HOD / PM / Appointed Staff HOD / PM
Date: Date:
(Name / Signature / Date) (Name / Signature / Date)

Section 3 Implementation Audit